The system that eats itself: From Wirtschaftswunder to Wartezimmer — A personal view of the German mental health care sector

Background. Germany’s mental health care system, despite high health expenditure and a long tradition of psychosomatic medicine, has entered a period of severe structural strain. The Robert Koch Institute panel data show that the share of adults at or above the depression-screening cut-off rose from 7.5% in 2020 to 14.8% in 2023 (RKI, 2025; Hapke et al., 2025). Mental illness–related work absences reached a new historical maximum in 2024 (DAK-Gesundheit, 2024), and average waiting times for outpatient psychotherapy now exceed twenty weeks in rural regions (BPtK, 2025). Position. In this Personal View, I argue — as the owner of a private psychosomatic clinic group operating inside this environment, and as the president of an academy concerned with the next generation of clinicians and researchers — that the German mental health field has entered a dead loop in which rising demand, contracting public capacity, structurally unprofitable private capacity, a two-tier insurance system that rations access by tier, and a workforce that is itself burning out, mutually reinforce one another. I draw on the sociology of burnout (Han, 2015; Ehrenberg, 2010), the individualisation thesis (Beck & Beck-Gernsheim, 2002), the empirical literature on family-system and psychosomatic care (Minuchin et al., 1978; Linden & Bernert, 2014; Köhler et al., 2023), and the value-based healthcare framework (Porter & Teisberg, 2006) to make the case that a holistic, individualised, family-centred model of psychosomatic care is both clinically necessary and, in the medium term, economically rational. Personal vision. My driving purpose, in everything I do at the Verus Care Group and at Singularity Academy, is to help families and children find a way out of what I have come to call the mental disorder trap — the recursive cycle in which an underfunded system, an exhausted workforce, and a culturally normalised disease vocabulary together imprison individuals and their families inside diagnostic identities they cannot escape and that the system, as currently configured, cannot help them resolve. I am especially concerned with mothers and children, because the next generation’s mental health is decided largely by what happens inside the family system in the early years. Conclusion. The essay proposes five concrete reform directions: reform of the PEPP/PsychVVG reimbursement regime so that high-quality psychosomatic inpatient care is not structurally unprofitable; properly financed psychotherapy and psychosomatic further-training pipelines; national investment in routine PROM/PREM measurement for mental health; a reframed cultural conversation about sick-leave and rehabilitation; and the formation of a private-clinic-owner forum to coordinate sector-level reform.